What Isn’t SM?

Selective mutism can sometimes be mistaken for other things (and vice versa). Here are some of the most common issues SM can be confused with, and how to differentiate between them.

Oppositional behavior: Selective mutism is sometimes mistaken for oppositional behavior because a child with SM might seem to be refusing to answer questions. In reality, children with SM are extremely anxious and experience SM as an inability to speak even when they want to. In other words, a child with SM is unable to speak, not refusing to speak.

Autism: Because autistic children and children with SM both struggle with socialization, the disorders can sometimes be mistaken for each other. However, even when kids with SM are in situations where they can’t speak, they can still pick up on nonverbal cues and emotional subtleties. Their socialization skills when they are at home with family look very typical. Autistic children, on the other hand, will struggle to interpret social nuances and the limits of conversation even when they are at home or in other comfortable surroundings.

Trauma: There is a misconception that children with selective mutism have been traumatized. While it is possible for a child to become mute after a traumatic experience, usually the child avoids talking about aspects of the trauma itself, rather than becoming completely silent. Post-traumatic stress disorder (PTSD) also has other symptoms like difficulty sleeping, nightmares and recreating the traumatic event during play, which makes it look quite different from SM.

Second language: When a child speaks a different language at home, care should be taken before diagnosing her with SM. Children should not be diagnosed with SM if their failure to speak can be explained by difficulty understanding or using a second language. Additionally, bilingual children commonly experience a “silent period” while they are acquiring their new language, so it is important not to mistake this stage of learning for SM.

However, bilingual children can still develop SM, and in fact the disorder is more common among children who are multi-lingual, although being bilingual doesn’t cause SM.

It is very important that bilingual children who are suspected to have SM have a thorough assessment that takes into account their language development and the history of their symptoms.

Social anxiety disorder: Also called social phobia, children with social anxiety disorder are afraid of being judged negatively by others. Speaking can be anxiety-provoking for them, as can writing in front of others, eating in front of others and performing. Social anxiety disorder frequently occurs along with SM. A thorough evaluation should be able to determine if a child has social anxiety disorder.